title: Plasma lipoprotein(a) concentration predicts future coronary and cardiovascular events in patients with stable coronary heart disease.
abstract: OBJECTIVE
  Association between lipoprotein(a) (Lp(a)) level and a first-ever coronary (CHD) event is recognized. Less is evident in patients with overt CHD and stable symptoms in whom we investigated associations between Lp(a) and future events.
  
  
  RESULTS
  Relationships between Lp(a) concentration and CHD and cardiovascular disease outcomes during 6 years' median follow-up were evaluated in the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) study. Lp(a) concentrations were measured in plasma from 7863 patients who had sustained a previous coronary event and been randomized to pravastatin or placebo. Lp(a) levels were categorized by lowest half, third quartile, 75th to 90th percentile, and highest decile. The prognostic value of Lp(a) on outcomes was assessed by fitting a Cox proportional-hazards model after adjustment for other risk factors and baseline cardiovascular disorders. The prognostic value of a change in Lp(a) at year 1 categorized by quartiles was assessed using Cox regression in a landmark model incorporating the above factors and baseline levels. Baseline Lp(a) concentration was associated with total CHD events (P<0.001), total cardiovascular disease events (P=0.002), and coronary events (P=0.03). Greatest risk occurred at >73 mg/dL, upper decile. For events after year 1, an increase in Lp(a) at 1 year was associated with adverse outcomes for total CHD events and total cardiovascular disease events (P=0.002 each).
  
  
  CONCLUSIONS
  In the LIPID study, baseline Lp(a) was associated with future cardiovascular disease and CHD events. Increased Lp(a) concentrations after 1 year were also associated with future events, supporting measurement of Lp(a) for risk assessment of patients with known CHD.
authors.affiliation: From the Lipoprotein and Atherosclerosis Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia (P.J.N.); NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia (E.H.B., J.S., M.F.); Department of Epidemiology & Preventative Medicine, Monash University, Melbourne, Australia (A.M.T.); Green Lane Cardiovascular Research Unit, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Medicine, University of Queensland, Brisbane, Australia (D.M.C.); Department of General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany (S.B.); and Royal Prince Alfred Hospital Department of Biochemistry, Sydney, Australia (D.R.S.).
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nestel
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Barnes
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Tonkin
authors.forename: John
authors.initials: J
authors.lastname: Simes
authors.forename: Marion
authors.initials: M
authors.lastname: Fournier
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.forename: David M
authors.initials: DM
authors.lastname: Colquhoun
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.forename: David R
authors.initials: DR
authors.lastname: Sullivan
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000628:therapy; D001315:Australia / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D003327:Coronary Disease / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000628:therapy; D009520:New Zealand / Q000453:epidemiology; D017035:Pravastatin / Q000627:therapeutic use; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017270:Lipoprotein(a); D017035:Pravastatin
keywords: cardiovascular diseases; coronary disease; lipoprotein(a); pravastatin